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PubMed2002

Carcinoma cervix with metastasis to deltoid muscle.

Skeletal muscles are rare metastatic sites despite their rich blood supply and the fact that the muscular mass of the body accounts for a large percentage of the total body weight. They account for less than 1% of all malignant metastases of haematogenous origin. Menard and Parache, Ann Med Interne Paris 1991;142:423-428. Skeletal muscle metastasis in cervical cancer have been infrequently reported. In this case report, we detail a case of cervical cancer who developed a painful swelling of the right shoulder which on investigation, was found to be skeletal muscle metastases.

Adult↗
PubMedDate not supplied

A new scoring system using multiple immunohistochemical markers for diagnosis of uterine smooth muscle tumors.

The diagnosis of uterine smooth muscle neoplasms by light microscopy is difficult. Multiple classification schemes have been proposed based on mitotic rate, nuclear atypia, and the presence or absence of necrosis. None of these classification systems has been entirely successful. This study was undertaken to evaluate the use of selected immunohistochemical and histochemical markers in differentiating these tumors, in addition to accepted morphologic criteria. Ten cases of each of the following: leiomyosarcomas (LMS), atypical leiomyomas (AL), cellular leiomyomas (CL) and usual leiomyomas (UL), were classically evaluated for histological diagnosis and were stained for Ki-67 (MIB-1), bcl- 2 and p53 using monoclonal antibodies and the avidin-biotin peroxidase method, and argyrophilic nucleolar organizer region (AgNORs). The number of stained cells was counted in the most positively stained region in a 4 mm2 square cover glass mounted on each slide. The mean value was calculated for each group of tumors. The data for Ki-67 (MIB- 1), bcl-2, p53 and AgNOR staining respectively, were significantly higher in LMS by comparison to UL, CL or AL. Because many singular cases had superimposed data being difficult to diagnose, a new scoring system for pathological evaluation was created. The results obtained by this scoring system suggest that immunohistochemical markers Ki-67 (MIB-1), bcl-2, p53 together with the AgNOR staining could be useful, by the scoring system, as an adjunct to the current accepted morphologic criteria in differentiating smooth muscle tumors of the uterus.

Antigens, Nuclear↗
PubMedDate not supplied

Ossified intramuscular hemangioma: multimodality imaging findings.

Whereas calcification of hemangiomas is common, ossification is unusual. Multimodality imaging findings of a rare case of an ossified intramuscular hemangioma in the calf of a 24-year-old woman are presented. Radiographic, computed tomographic, magnetic resonance (MR), scintigraphic, and histologic features of this case are reported. The radiologic differential diagnosis of an ossified mass in soft tissue is also discussed.

Adult↗
PubMed1999

Possible role of calponin h1 as a tumor suppressor in human uterine leiomyosarcoma.

BACKGROUND: Calponin h1, a basic actin-binding protein capable of inhibiting smooth muscle contraction, is a constitutive element of smooth muscle cells. However, in leiomyosarcoma (a type of smooth muscle neoplasm of the uterus), reduced expression of calponin h1 is observed, as we have reported previously. In this study, we sought to assess the effects (in vitro and in vivo) of increasing calponin h1 expression in leiomyosarcoma cells. METHODS: A plasmid containing a human calponin h1 complementary DNA and a bacterial neomycin-resistance gene was transfected into the human leiomyosarcoma cell lines SKN and SK-LMS-1 by electroporation. Southern blotting, reverse transcription-polymerase chain reaction analysis, western blotting, and immunohistochemistry were used to confirm DNA transfer and expression of the calponin h1 protein in neomycin-resistant clones. We characterized the morphology of calponin h1-transfected cells, and we evaluated their proliferative activity and tumorigenicity by use of a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay, an anchorage-independent growth assay, and a nude mouse tumorigenicity assay. RESULTS: The morphology of calponin h1-transfected cells in culture resembled that of cultured normal myometrial smooth muscle cells. With SK-LMS-1 cells, proliferation of calponin h1-transfection cells was reduced to 69% of control; with SKN cells, calponin h1 transfection reduced proliferation to 70% of control. In assays of anchorage-independent growth and in vivo tumorigenicity, both growth and tumorigenicity were statistically significantly reduced in calponin h1-transfected leiomyosarcoma cells. CONCLUSIONS: Calponin h1 may function as a tumor suppressor in leiomyosarcoma. Clinically, transfer of a calponin h1 complementary DNA into poorly differentiated leiomyosarcoma cells may be of potential therapeutic value through induction of a normal, differentiated cellular phenotype.

Animals↗
PubMed1986

Epithelioid leiomyosarcoma of the uterus.

Uterine epithelioid leiomyosarcoma is an unusual smooth muscle neoplasm. It is distinguished on cytoarchitectural grounds from the majority of leiomyosarcomas that arise in the uterus. Three cases of this atypical lesion are presented and the pathologic features are discussed. One patient is alive with no evidence of disease at 3.5 years, one patient has persistent disease at 4 years, and the third patient died of disease at 8 months. Fundamental differences in biologic behavior of this subset of uterine smooth muscle tumors cannot be discerned.

Adult↗
PubMed2006

Early post-transplant smooth muscle neoplasia of the colon presenting as diminutive polyps: a case complicating post-transplant lymphoproliferative disorder.

A 44-year-old woman, 3 years post-transplant for pulmonary sarcoidosis, developed abdominal pain and diarrhea 13 months subsequent to an eradicated diffuse large B-cell-type, post-transplant lymphoproliferative disorder (PTLD) of the cecal region. Endoscopic examination identified multiple pale tan 5-to-9 mm rubbery nodules of the transverse and right colon in an otherwise unremarkable mucosa. Histology was characterized by bland smooth muscle proliferations, focally pushing into the mucosa. Immunohistochemistry (IHC), in situ hybridization (ISH), and polymerase chain reaction (PCR) of the sampled nodules confirmed Epstein-Barr virus (EBV) infection of neoplastic cells. To our knowledge, this is the first reported case of EBV-related post-transplant lymphoproliferative and smooth muscle neoplasms (PTSN) having distinct tropism for the colon. Endoscopic features of early PTSN, which in this case presented as diminutive polypoid lesions, have not been described previously.

Adult↗
PubMed2006

Recurrence in skeletal muscle from squamous cell carcinoma of the uterine cervix: a case report and review of the literature.

BACKGROUND: The occurrence of skeletal muscle metastases is a very rare event. Only two cases of late skeletal muscle recurrence from cervical cancer have been documented until now. CASE PRESENTATION: A 38-year old patient, submitted to radical hysterectomy and pelvic lymphadenectomy for a squamous FIGO stage IB1 cervical carcinoma, presented after 76 months with a palpable, and painless swelling on the left hemithorax. MRI showed a nodule located in the context of the intercostal muscles. Pathology revealed the presence of metastasis of squamous cell carcinoma of similar morphology as the primary. On the basis of FDG-PET findings, which excluded other sites of disease, surgical excision of the lesion was performed. The patient was triaged to chemotherapy plus external radiotherapy. CONCLUSION: A case of skeletal muscle recurrence from cervical cancer after a very long interval from primary diagnosis is reported. Muscular pain or weakness, or just a palpable mass in a patient with a history of cancer has always to raise the suspicion of muscle metastasis.

Adult↗
PubMed2004

Intramuscular thrombosed arteriovenous hemangioma of the upper right arm mimicking a neuroma of the ulnar nerve: case report.

OBJECTIVE AND IMPORTANCE: Soft tissue arteriovenous hemangiomas (AHs) are benign vascular hamartomas characterized by the presence of arteriovenous shunts. Few cases of soft tissue AHs have been found in the literature, and these were frequently described as cutaneous lesions of the limb or of the scalp. Intramuscular AHs are extremely rare. AHs are prevalent in children and women and are often associated with other types of malformations or genetic disorders. We present the case of an elderly woman with an intramuscular thrombosed AH on the volar side of the upper right arm. Owing to the close proximity of the ulnar nerve, this lesion was initially identified as a neuroma. CLINICAL PRESENTATION: A 70-year-old woman presented with a short history (a few months) of progressive growth of a nonpulsating, solid, palpable mass deeply localized in the distal third of the right upper arm. At the neurological examination, local evoked pain was the only sign detected. A Doppler ultrasound examination depicted a hyperechoic spherical lesion with widespread calcium deposits and necrosis. INTERVENTION: The exploration of the upper arm revealed a capsulated nodular lesion, 7 cm in diameter, that morphologically corresponded to a thrombosed vascular lesion. This lesion was removed en bloc, and an unequivocal connection with a muscular branch of the ulnar artery was detected. The histological analysis revealed AH. CONCLUSION: Intramuscular AHs are rare and may easily be misdiagnosed as neuromas, especially when they are contiguous to a peripheral nerve.

Aged↗
PubMed1994

Meckel's diverticulum-rare complications and review of the literature.

Meckel's diverticulum is the most common congenital anomaly of the gastro-intestinal tract. It arises as a result of incomplete dissolution of the vitello-intestinal duct. Approximately 4% of patients with Meckel's diverticula develop complications, most commonly obstruction, gastro-intestinal bleeding and inflammation. We describe three unusual presentations of Meckel's diverticulum-perforation due to ingested foreign body, a smooth muscle neoplasm simulating an ovarian tumour, and a Littre's hernia.

Adult↗
PubMed1999

Dissecting leiomyomas of the uterus other than cotyledonoid dissecting leiomyomas: a report of eight cases.

We report eight cases of benign uterine smooth muscle neoplasms with unusual growth patterns and intramural dissection. All the patients in our series were of reproductive age or perimenopausal (range, 36-51 years) and had an enlarged uterus or a pelvic mass, with the exception of one lesion that was found incidentally in a patient treated for uterine prolapse. Three also had abnormal uterine bleeding. On gross examination, the lesions had an unusual appearance and were often lobulated and irregular with indistinct margins. On microscopic examination of all the lesions in this study, a dominant benign smooth muscle tumor was associated with intramural dissection of the myometrium by fascicles of neoplastic smooth muscle. Of the eight cases showing intramural dissection, four were intramural dissecting leiomyomas; three were examples of intravenous leiomyomatosis; and one was a multinodular leiomyoma with hydropic degeneration. We excluded cotyledonoid dissecting leiomyomas from the study. In two of the three cases of intravenous leiomyomatosis, extrauterine extensions in continuity with the intramural components were noted at surgery and on gross examination. Intramural dissection of the myometrium by a benign smooth muscle tumor is one additional possibility to be considered in the differential diagnosis of leiomyosarcoma and low-grade stromal sarcoma.

Adult↗
PubMed1985

Apoplectic leiomyomas of the uterus. A clinicopathologic study of five distinctive hemorrhagic leiomyomas associated with oral contraceptive usage.

Five histologically distinctive uterine smooth muscle neoplasms with multifocal hemorrhages termed apoplectic leiomyomas were studied. All patients were found to have been taking a combination-type oral contraceptive hormonal medication containing the progestin norethindrone for 2-4 years. Abdominal pain was the most frequent presenting symptom. The tumors ranged in size from about 1.1 to 4 cm and had multiple gross hemorrhages. Microscopically, they were characterized by stellate zones of recent hemorrhage within nodules of hypercellular smooth muscle. Coagulative necrosis, as seen in "red degeneration," was inconspicuous. Mitotic figures were sparse, not exceeding 2/10 HPF, and were mostly located in the perihemorrhagic areas. Abnormal blood vessels of various sizes were frequent and may have led to the hemorrhages. No recurrences developed up to 12 years after operation. A causal relationship between apoplectic leiomyomas and oral contraceptive usage is strongly suggested. Recognition of their distinctive pathologic features will prevent misdiagnosis as leiomyosarcoma.

Adult↗
PubMed1998

Molecular features in a biphenotypic small cell sarcoma with neuroectodermal and muscle differentiation.

We report a case of a 13-year-old girl with soft tissue sarcoma of the hand, which showed muscle and neuroectodermal immunophenotypes. Molecular studies were performed on RNA collected from fine-needle aspiration (FNA) cytology and peripheral blood samples by nested reverse transcriptase-polymerase chain reaction (RT-PCR) and Southern blot analysis. This biphenotypic tumor showed simultaneous expression of EWS-FLI1 and PAX3-FKHR transcripts, specific of Ewing family tumors and alveolar rhabdomyosarcoma, respectively. Although childhood sarcomas with simultaneous muscle and neural differentiation have been described to have EWS-FLI1 transcripts, there are no reports of tumors with both transcripts. Cytological specimens are a good source of RNA for molecular studies.

Adolescent↗
PubMed2001

Apoptosis and Fas-ligand expression correlate to the histopathological grade of gastric smooth muscle tumors.

BACKGROUND: Apoptosis is associated with the tumor grade in various types of carcinomas or lymphomas, but less is understood about the association of apoptosis in mesenchymal tumors. In the prior studies, expression of apoptotic regulatory proteins, Bcl-2, Fas and its ligand, Fas-ligand, has been related to apoptotic index (AI) and histopathological grade of tumors. Our study investigated the incidence of apoptosis in gastric smooth muscle tumor and the correlation of the apoptotic index (AI) with the histopathological grade of the tumors. We evaluated the relationship of apoptotic regulatory proteins to the AI and tumor grade. METHODS AND MATERIALS: Using immunohistochemistry and the terminal deoxynucleotidyl transferase (TdT)-mediated digoxigenin-dUTP nick end-labeling (TUNEL) assay, we analyzed the expression of Bcl-2, Fas, Fas-ligand, and AI in 26 cases of gastric smooth muscle tumors. RESULTS: The incidence of greater than 10 apoptotic cells per 10 high-power fields (HPFs) was 73% (19/26 cases). The AI was significantly associated with malignant tumors (P = 0.006) and mitotic counts (P = 0.006) but not with tumor size. Bcl-2, Fas, and Fas-ligand were detected in 13 (50%), 14 (53.8%), and 19 (73%) cases, respectively. Interestingly, Fas-ligand was significantly correlated to malignancy (P = 0.006), mitotic counts (P = 0.006), and AI (P = 0.035) but not to tumor size. Fas expression was significantly associated with high levels of AI (P = 0.014). In contrast, Bcl-2 expression was inversely associated with AI (P = 0.004). Expression of Bcl-2 and Fas did not show a statistically significant correlation with tumor grade, mitotic counts, or tumor size. CONCLUSION: Apoptosis and Fas-ligand expression are statistically correlated to the histopathological grade of gastric smooth muscle tumors. This suggests that detection of apoptotic cells and Fas-ligand expression using the TUNEL assay or immunohistochemistry are useful for the evaluation of the malignant potential of gastric smooth muscle tumors.

Adult↗
PubMed2003

Skeletal muscle metastasis from transitional cell carcinoma of the urinary bladder: clinicoradiological features.

AIM: To define the clinicoradiological characteristics of skeletal muscle metastasis from transitional cell carcinoma of the urinary bladder. MATERIALS AND METHODS: A retrospective review of all patients with skeletal muscle metastasis was undertaken between January 1999 to December 2001. Patients suspected of having a metastasis on radiological examinations, and subsequently proven to have metastatic disease on histological examination were included in study. The clinical presentation and radiological features of five patients with skeletal muscle metastasis from bladder tumours were reviewed from hospital records. RESULTS: Twenty-four patients had skeletal muscle metastasis from various primaries. Of these five patients had previous or concurrent primary tumours in the bladder. Patients were aged between 27-70 years (mean 52 years), and all had persistent, localized pain with or without accompanying swelling. The muscles involved were psoas in three patients, adductor muscles of thigh in one and rectus abdominis in one. Four patients had radical cystectomy with urinary diversion (two ileal conduit and two orthotopic sigmoid neobladder). One patient presented with bladder tumour and concomitant muscular metastasis. All patients underwent helical computed tomography (CT) before confirmation of diagnosis by fine-needle aspiration (FNA) or biopsy. The typical appearance of low-density enhancing lesions on CT was mistaken for abscess in two patients and failure to respond to conservative treatment led to suspicion of metastasis. Diagnosis was proven histologically in all patients (FNA in three and biopsy in two). All patients had palliative chemotherapy (Mitomycin, Vincristine, Adriamycin and Cyclophosphamide). Two patients had local palliative 3500 rad radiotherapy for persistent pain. Mean survival was 8 months (range 6-12 months). CONCLUSION: Muscular metastasis from urothelial tumours typically presents with persistent localized pain with or without swelling. The characteristic low-density, ring-enhancing lesions on CT in a patient with previous or concomitant urothelial tumours should raise the suspicion of metastasis until proven otherwise. Prognosis is dismal.

Adult↗
PubMedDate not supplied

Immunohistochemical analysis of a primary ovarian leiomyosarcoma. Case report.

BACKGROUND: Primary ovarian leiomyosarcoma is an extremely rare malignant smooth muscle neoplasm. We report a case of a primary leiomyosarcoma of the ovary managed at our institution. CASE REPORT: Surgical exploration in a 71-year-old woman revealed a large left adnexal tumor and one separate metastatic implant in one part of the omentum, being classified as a primary ovarian leiomyosarcoma stage III C. The patient was treated with an adjuvant chemotherapy regimen consisting of cisplatin and ifosfamide. The patient remained without any evidence of disease until she died due to apoplexy 14 months after initial surgery. High cellularity, nuclear polymorphism as well as patchy necrosis and large areas of hemorrhage, characterized the tumor. Mitotic activity exceeded 5 mitoses per 10 high-power fields with lots of atypical mitoses. Immunohistochemically, the tumor showed a strong positive staining reaction for muscle actin, alpha-smooth muscle actin and neuron-specific enolase as well as a weak positive reaction for vimentin. Furthermore, immunohistochemistry revealed a positive staining for Ki-67, MMP-1 and MMP-2, and VEGF. CONCLUSION: Until recently, prognostic parameters in ovarian leiomyosarcoma have still not been identified. Thus, the prognostic value of different clinicopathological and immunohistochemical parameters, especially Ki-67, MMPs and VEGF, should be proven in additional cases with long-term follow-up.

Aged↗